Pediatric Rome Criteria — Disorders of Gut‑Brain Interaction (DGBI)

Key Feature: Nausea and/or vomiting that cannot be fully explained by organic disease after appropriate medical evaluation.

Key Feature: Recurrent, discrete episodes of intense nausea and vomiting with symptom-free intervals.

Diagnostic Criteria (Rome IV)

• Two or more periods of intense, unremitting nausea and paroxysmal vomiting, lasting hours to days within a 6‑month period.
• Episodes are stereotypical in each patient.
• Episodes are separated by weeks to months with return to baseline health between episodes.
• After appropriate evaluation, the symptoms cannot be attributed to another medical condition.

Key Feature: Persistent nausea or vomiting, respectively, that is not fully explained by organic causes.

H1b1. Functional Nausea

Diagnostic Criteria (Rome IV)

• Bothersome nausea as the predominant symptom, occurring at least twice per week, and generally not related to meals.
• Not consistently associated with vomiting.
• After appropriate evaluation, the nausea cannot be fully explained by another medical condition.
• Criteria fulfilled for at least 2 months prior to diagnosis.

H1b2. Functional Vomiting

Diagnostic Criteria (Rome IV)

• On average, one or more episodes of vomiting per week.
• Absence of self-induced vomiting or criteria for an eating disorder or rumination.
• After appropriate evaluation, the vomiting cannot be fully explained by another medical condition.
• Criteria fulfilled for at least 2 months prior to diagnosis.

Key Feature: Repeated regurgitation, rechewing, or expulsion of food, without retching.

Diagnostic Criteria (Rome IV)

• Repeated regurgitation and rechewing or expulsion of food that begins soon after ingestion of a meal.
• Does not occur during sleep.
• Not preceded by retching.
• After appropriate evaluation, symptoms cannot be fully explained by another medical condition; an eating disorder must be ruled out.
• Criteria fulfilled for at least 2 months prior to diagnosis.

Key Feature: Excessive air swallowing leading to abdominal distension, belching, and/or increased flatus.

Diagnostic Criteria (Rome IV)

• Excessive air swallowing.
• Abdominal distention due to intraluminal air which increases during the day.
• Repetitive belching and/or increased flatus.
• After appropriate evaluation, symptoms cannot be fully explained by another medical condition.
• Criteria fulfilled for at least 2 months prior to diagnosis.

Key Feature: Abdominal pain that cannot be fully explained by organic disease after appropriate medical evaluation.

Key Feature: Upper GI distress symptoms including postprandial fullness, early satiation, and/or epigastric pain or burning.

Diagnostic Criteria (Rome IV)

• One or more of the following bothersome symptoms at least 4 times a month for at least 2 months prior to diagnosis: postprandial fullness; early satiation; epigastric pain or burning not associated with defecation.
• After appropriate evaluation, symptoms cannot be fully explained by another medical condition.

Subtypes

• H2a1. Postprandial Distress Syndrome (PDS): Bothersome postprandial fullness or early satiation preventing finishing a regular meal.
• H2a2. Epigastric Pain Syndrome (EPS): Bothersome pain or burning localized to the epigastrium, not relieved by defecation.

Key Feature: Abdominal pain associated with changes in stool frequency or form.

Diagnostic Criteria (Rome IV)

• Abdominal pain at least 4 days per month over at least 2 months associated with one or more of: related to defecation; change in frequency of stool; change in form (appearance) of stool.
• In children with abdominal pain and constipation, the pain does not resolve with resolution of constipation (if it does resolve, classify as functional constipation, not IBS).
• After appropriate evaluation, symptoms cannot be fully explained by another medical condition.
• Criteria fulfilled for at least 2 months prior to diagnosis.

Key Feature: Paroxysmal episodes of intense abdominal pain with associated symptoms such as nausea, vomiting, and headache.

Diagnostic Criteria (Rome IV)

• All of the following occurring at least twice: paroxysmal episodes of intense, acute periumbilical/midline/diffuse abdominal pain lasting ≥1 hour; episodes separated by weeks to months; pain is incapacitating and interferes with normal activities; stereotypical pattern and symptoms in the patient; pain associated with two or more of anorexia, nausea, vomiting, headache, photophobia, pallor.
• After appropriate evaluation, symptoms cannot be fully explained by another medical condition.
• Criteria fulfilled for at least 6 months prior to diagnosis.

Key Feature: Abdominal pain that does not meet criteria for IBS, FD, or abdominal migraine.

Diagnostic Criteria (Rome IV)

• Must occur at least 4 times per month and include: episodic or continuous abdominal pain not solely during physiologic events; insufficient criteria for IBS, FD, or abdominal migraine; after appropriate evaluation, pain cannot be fully explained by another medical condition.
• Criteria fulfilled for at least 2 months prior to diagnosis.

Key Feature: Problems with defecation (constipation or incontinence) that are not fully explained by organic causes.

Key Feature: Infrequent or difficult bowel movements.

Diagnostic Criteria (Rome IV)

• Two or more of the following at least once per week for ≥1 month with insufficient criteria for IBS: two or fewer defecations per week in a child developmental age ≥4 years; ≥1 episode of fecal incontinence per week; history of retentive posturing or excessive volitional stool retention; history of painful or hard BMs; presence of a large fecal mass in rectum; history of large diameter stools that can obstruct toilet.
• After appropriate evaluation, symptoms cannot be fully explained by another medical condition.

Key Feature: Defecation in inappropriate places without evidence of fecal retention.

Diagnostic Criteria (Rome IV)

• At least a 1‑month history in a child with developmental age >4 years of: defecation in inappropriate places; no evidence of fecal retention; after appropriate evaluation, fecal incontinence cannot be explained by another medical condition.